August 14, 2014

Garrett: You are not nearly scared enough about Ebola

Last week, my brilliant Council on Foreign Relations colleague John Campbell, former U.S. ambassador to Nigeria, warned that spread of the virus inside Lagos -- which has a population of 22 million -- would instantly transform this situation into a worldwide crisis, thanks to the chaos, size, density, and mobility of not only that city but dozens of others in the enormous, oil-rich nation.

Add to the Nigerian scenario civil war, national elections, Boko Haram terrorists, and a country-wide doctors' strike -- all of which are real and current -- and you have a scenario so overwrought and frightening that I could not have concocted it even when I advised screenwriter Scott Burns on his Contagion script.

Inside the United States, politicians, gadflies, and much of the media are focused on wildly experimental drugs and vaccines, and equally wild notions of "keeping the virus out" by barring travelers and "screening at airports."

Let's be clear: Absolutely no drug or vaccine has been proven effective against the Ebola virus in human beings. To date, only one person -- Dr. Kent Brantly -- has apparently recovered after receiving one of the three prominent putative drugs, and there is no proof that the drug was key to his improvement.

None of the potential vaccines has even undergone Phase One safety trials in humans, though at least two are scheduled to enter that stage before December of this year. And Phase One is the swiftest, easiest part of new vaccine trials -- the two stages of clinical trials aimed at proving that vaccines actually work will be difficult, if not impossible, to ethically and safely execute.

If one of the vaccines is ready to be used in Africa sometime in 2015, the measure will be executed without prior evidence that it can work, which in turn will require massive public education to ensure that people who receive the vaccination do not change their behaviors in ways that might put them in contract with Ebola -- because they mistakenly believe they are immune to the virus.

We are in for a very long haul with this extremely deadly disease -- it has killed more than 50 percent of those laboratory-confirmed infections, and possibly more than 70 percent of the infected populations of Liberia, Sierra Leone, and Guinea. Nigeria is struggling to ensure that no secondary spread of Ebola comes from one of the people already infected by Liberian traveler Patrick Sawyer -- two of whom have died so far.

That effort expanded on Wednesday, when Nigerian health authorities announced that a nurse who had treated Sawyer escaped her quarantine confinement in Lagos and traveled to Enugu a city that, as of 2006, has a population of about three million. Though the nurse has not shown symptoms of the disease, the incubation time for infection, which is up to 21 days, hasn't elapsed.

Since the Ebola outbreak began in March there have been many reports of isolated cases of the disease in travelers to other countries. None have resulted, so far, in secondary spread, establishing new epidemic focuses of the disease. As I write this, such a case is thought to have occurred Johannesburg, South Africa's largest city, and another suspected case reportedly died in isolation in Jeddah, Saudi Arabia, prompting the kingdom to issue special Ebola warnings for the upcoming hajj.

It's only a matter of time before one of these isolated cases spreads, possibly in a chaotic urban center far larger than the ones in which it is now claiming lives: Conakry, Guinea; Monrovia, Liberia; and Freetown, Sierra Leone.

The Saudi and South African cases she mentions have very recently tested negative, but Garrett's point remains valid.

Ebola punches far, far above its weight. In a region with a quarter-billion people, probably fewer than 3,000 have contracted it, even counting missed cases. Yet the disease has shaken West Africa's economies, societies, and governments, and the rumbles are being felt around the world. If Ebola does escape from its present limits, the rumbles will become a deafening roar.

Comments

Last week, my brilliant Council on Foreign Relations colleague John Campbell, former U.S. ambassador to Nigeria, warned that spread of the virus inside Lagos -- which has a population of 22 million -- would instantly transform this situation into a worldwide crisis, thanks to the chaos, size, density, and mobility of not only that city but dozens of others in the enormous, oil-rich nation.

Add to the Nigerian scenario civil war, national elections, Boko Haram terrorists, and a country-wide doctors' strike -- all of which are real and current -- and you have a scenario so overwrought and frightening that I could not have concocted it even when I advised screenwriter Scott Burns on his Contagion script.

Inside the United States, politicians, gadflies, and much of the media are focused on wildly experimental drugs and vaccines, and equally wild notions of "keeping the virus out" by barring travelers and "screening at airports."

Let's be clear: Absolutely no drug or vaccine has been proven effective against the Ebola virus in human beings. To date, only one person -- Dr. Kent Brantly -- has apparently recovered after receiving one of the three prominent putative drugs, and there is no proof that the drug was key to his improvement.

None of the potential vaccines has even undergone Phase One safety trials in humans, though at least two are scheduled to enter that stage before December of this year. And Phase One is the swiftest, easiest part of new vaccine trials -- the two stages of clinical trials aimed at proving that vaccines actually work will be difficult, if not impossible, to ethically and safely execute.

If one of the vaccines is ready to be used in Africa sometime in 2015, the measure will be executed without prior evidence that it can work, which in turn will require massive public education to ensure that people who receive the vaccination do not change their behaviors in ways that might put them in contract with Ebola -- because they mistakenly believe they are immune to the virus.

We are in for a very long haul with this extremely deadly disease -- it has killed more than 50 percent of those laboratory-confirmed infections, and possibly more than 70 percent of the infected populations of Liberia, Sierra Leone, and Guinea. Nigeria is struggling to ensure that no secondary spread of Ebola comes from one of the people already infected by Liberian traveler Patrick Sawyer -- two of whom have died so far.

That effort expanded on Wednesday, when Nigerian health authorities announced that a nurse who had treated Sawyer escaped her quarantine confinement in Lagos and traveled to Enugu a city that, as of 2006, has a population of about three million. Though the nurse has not shown symptoms of the disease, the incubation time for infection, which is up to 21 days, hasn't elapsed.

Since the Ebola outbreak began in March there have been many reports of isolated cases of the disease in travelers to other countries. None have resulted, so far, in secondary spread, establishing new epidemic focuses of the disease. As I write this, such a case is thought to have occurred Johannesburg, South Africa's largest city, and another suspected case reportedly died in isolation in Jeddah, Saudi Arabia, prompting the kingdom to issue special Ebola warnings for the upcoming hajj.

It's only a matter of time before one of these isolated cases spreads, possibly in a chaotic urban center far larger than the ones in which it is now claiming lives: Conakry, Guinea; Monrovia, Liberia; and Freetown, Sierra Leone.

The Saudi and South African cases she mentions have very recently tested negative, but Garrett's point remains valid.

Ebola punches far, far above its weight. In a region with a quarter-billion people, probably fewer than 3,000 have contracted it, even counting missed cases. Yet the disease has shaken West Africa's economies, societies, and governments, and the rumbles are being felt around the world. If Ebola does escape from its present limits, the rumbles will become a deafening roar.